Epidemiology Monthly

Surveillance Report Florida Department of Health in Orange County

Primary Amebic Meningoencephalitis/Amoeba Summit 2015 September 11th, Orlando, Florida

August 2015

Volume 6, Issue 8

Points of Interest:

PAM Summit

West Nile Virus Advisory

Influenza-like illness

remains at seasonal low

levels

2015 PAM Summit 1

Influenza Surveillance 2

Vibrio / Ebola

Surveillance

3

Gastrointestinal

Illness Surveillance

4

Arboviral Surveillance 5

Reportable Disease

Table

6

West Nile Virus

Advisory Update

7

Contact Information 8

Primary Amebic Meningoencephalitis (PAM) is a devastating infection that

historically has a case fatality rate of close to 100 percent; however, in the

summer of 2013, 2 patients in the United States have survived as a result of early

recognition and implementation of treatment. The only other documented survival

case in the U.S. was in 1978. With the abundance of freshwater bodies in Florida,

and the warm climate, this state has seen more cases of PAM than any other

state.

This “first of its kind” event is hosted and sponsored by Florida Hospital for

Children (Orlando, Florida), and presented by the Jordan Smelski Foundation for

Amoeba Awareness and the Florida Department of Health in Seminole County, in

partnership with the Florida Department of Health in Orange County.

The event is intended for clinicians, researchers, and public health professionals

and will be held from 7:30 AM until 2:30 PM, Friday, September 11th. In-person

attendance has been approved for FMA Accreditation Program with AMA PRA

Category 1 Credit™.

The Summit will be held at Florida Hospital Church, 2800 N. Orange Ave,

Orlando, FL 32804.

To Reserve a Seat, Please RSVP at 407-303-KIDS (5437)

Among the six presenters will be Alenjandro Jordan-Villegas, MD, Infectious

Disease Specialist, Florida Hospital for Children, William M. Linam, MD, Pediatric

Infectious Disease Specialist, Arkansas Children’s Hospital, and Francine

Marciano-Cabral, PhD, Department of Microbiology and Immunology, Virginia

Commonwealth University School of Medicine.

This conference will also be available as a live webcast at:

www.Hospitalchurch.org/livestream, and will also be available for post-

event viewing through the same website. At this time, FMA Accreditation

Program AMA PRA Category 1 Credit™ is not approved for the web viewing.

Primary Amebic Meningoencephalitis Resources

Florida Department of Health CDC

Page 2 Epidemiology Monthly Surveillance Report

Influenza Surveillance (data from Florida Flu Review)

National

In Minnesota, the first case of human infection with influenza A H3N2 variant virus (H3N2v) in the US in

2015 (week 29) occurred after direct exposure to swine. No evidence of human-to-human transmission of

H3N2v or any influenza-like illness among the case’s contacts was reported. More information on this

novel influenza virus can be found here, and information on other novel flu viruses can be found here.

Florida

Emergency department (ED) and urgent care

center (UCC) ILI visits reported into ESSENCE

-FL (Florida’s syndromic surveillance system)

remain low, which is typical for this time of

year.

In weeks 31 and 32, 20 specimens were

submitted to Bureau of Public Health

Laboratories for influenza testing. Two

specimens (19%) tested positive for influenza

A (H3) by polymerase chain reaction.

Orange County

No outbreaks of influenza-like illness were reported to DOH-Orange in August 2015. A two person outbreak of influenza A (H3) was reported in a nursing home in June 2015.

Influenza Resources:

Florida Department of Health Weekly Influenza Activity Report

Center for Disease Control and Prevention Weekly Influenza Activity Report

Influenza-like Illness from Emergency Department Visits in Orange County, 2012 to 2015

The map above shows the number

of outbreaks reported in each

Florida county since week 20, 2015,

as reported by 11 a.m. August 19,

2015.

Page 3 Volume 6, Issue 6

Vibrio vulnificus Surveillance

Ebola Surveillance

Ebola Resources: Patient Screening Tool: Florida Department of Health Florida Department of Health EVD Resources

Centers for Disease Control and Prevention: Ebola Information and Guidance

World Health Organization: Global Alert and Response Situation Reports

Florida Per Executive Order Number 14-280 issued by the Office of the Governor, the Florida Department of Health

continues the practice of twice daily in-person temperature monitoring and symptom checking of all travelers from Guinea, Liberia, and Sierra Leone during their 21-day Ebola incubation period.

Ebola continues to represent a very low risk to the general public in Florida and the United States.

Physicians should immediately call the local health department if a patient fits the criteria of an Ebola

Patient Under Investigation (link to Patient Screening Tool below).

International Updated September 1, 2015:

Liberia, originally declared Ebola-free on May 9, has reported additional cases since June 28, 2015. However, no cases have been identified in the past 21 days. Sierra Leone has gone longer than 21 days without identification of a new case. Guinea continues to experience disease transmission during the past 21 days.

Total Cases:

Liberia: 10,672

Sierra Leone: 13,409

Guinea: 3,792

Days Since Last Case via CDC

Vibrio vulnificus is a bacterium that normally lives in warm seawater and is part of a group of vibrios that

are called “halophilic” because they require salt. Vibrio vulnificus infections are rare. Vibrio vulnificus is a

naturally occurring bacterium in warm, brackish seawater. Water and wounds do not mix. Do not enter the

water if you have fresh cuts or scrapes.

Florida Department of Health Vibrio Information Page

2010 2011 2012 2013 2014 2015

Orange County 0 0 0 1 1 0

Florida 32 35 26 42 31 26

Vibrio vulnificus Cases in Orange County and Florida, 2010 to 2015 (YTD)

Page 4 Epidemiology Monthly Surveillance Report

Gastrointestinal Illness Surveillance

34 cases of Salmonellosis were reported among Orange County residents in August 2015. This

represents an increase from July 2015, but is still within the seasonal expected disease incidence trend

for Salmonellosis. One case of Cyclosporiasis was reported during August 2015.

During August, 11 foodborne illness complaints were reported to the Florida Department of Health in

Orange County for investigation.

One waterborne outbreak at an Orange County resort of cryptosporidium was reported in August.

Gastrointestinal Illness Resources:

Florida Online Foodborne Illness Complaint Form - Public Use Florida Food and Waterborne Disease Program Florida Food Recall Searchable Database Florida Department of Health - Norovirus Resources CDC: A-Z Index for Foodborne Illness CDC: Healthy Water

Select Reportable Enteric Diseases in Orange County, Florida, August 2014 to August 2015

Gastrointestinal Illness Points of Interest:

Arboviral Surveillance

Page 5 Volume 6, Issue 6

Weekly Florida Arboviral Activity Report (Released on Mondays) Orange County Mosquito Control

Arboviral Resources:

Florida Department of Health Chikungunya Information

CDC Chikungunya Information

CDC Chikungunya MMWR

Florida

Chikungunya Resources

Bay, Gadsden,

Hillsborough, Orange,

Pinellas, Polk, and

Volusia Counties are

currently under

mosquito-borne illness

advisory. Escambia and

Walton Counties are

currently under

mosquito-borne illness

alert.

One human case of

West Nile Virus (WNV)

infection was reported

this week in Pinellas

County.

Orange County

No human cases of West Nile Virus, Chikungunya Virus, St. Louis Encephalitis Virus, Eastern

Equine Encephalitis Virus, or Dengue Virus were reported among Orange County residents during

August 2015.

In August, five sentinel chickens tested positive for West Nile Virus (WNV) in Orange County.

Prior to August 2015, 15 sentinel chickens and 1 horse have tested positive for EEEV and 1

sentinel chicken tested positive for Highlands J Virus in Orange County.

Disease

ORANGE All Counties

August Cumulative

(YTD) August

Cumulative

(YTD)

2015 Mean

5yr 2015

Mean

5yr 2015

Mean

5yr 2015

Mean

5yr

Amebic Encephalitis 0 0 0 0 0 0.4 1 0.8

Arsenic Poisoning 0 0 1 0 1 0.6 13 5.6

Brucellosis 0 0 1 0.2 3 0.4 10 7

Campylobacteriosis 12 10.6 88 78 321 255 2570 1651

Carbon Monoxide Poisoning 10 0 13 2.8 35 10 167 96.6

Chikungunya Fever 0 1.8 3 4.8 11 11.8 100 43.8

Cholera (Vibrio cholerae Type O1) 0 0 2 0 0 0.4 4 3.4

Ciguatera Fish Poisoning 0 0 1 0.2 5 12.2 26 30.8

Creutzfeldt-Jakob Disease (CJD) 0 0.2 1 0.4 1 2.6 18 13.4

Cryptosporidiosis 1 8 29 23.8 169 137 545 414

Cyclosporiasis 1 0.2 2 2.8 8 5.8 21 40.4

Dengue Fever 0 1.6 1 7 8 27 37 79.6

Escherichia coli: Shiga Toxin-Producing (STEC) Infection 0 2.4 16 9.4 49 50.6 313 282.6

Giardiasis: Acute 6 10.2 53 45.8 107 151.2 679 882.2

Haemophilus influenzae Invasive Disease 0 0.4 5 10.4 14 15.4 120 176

Hansen's Disease (Leprosy) 1 0 2 0.2 3 1.8 19 6.8

Hemolytic Uremic Syndrome (HUS) 0 0.4 1 0.6 0 0.6 4 4

Hepatitis A 0 1.2 1 4.8 14 12.6 92 81.2

Hepatitis B: Acute 0 1.2 9 7.8 40 26 336 210.4

Hepatitis B: Chronic 41 40.2 353 265 508 415.2 3817 3040.4

Hepatitis B: Surface Antigen in Pregnant Women 6 5.2 48 44 25 36.8 289 336.6

Hepatitis C: Acute 1 0.8 4 6.6 22 14.4 126 108.4

Hepatitis C: Chronic 171 138 1332 1124.8 3232 2448.2 24795 18662.4

Lead Poisoning 2 1 16 18 84 85 615 557.6

Legionellosis 2 3.4 11 12.2 43 25 222 148

Leptospirosis 0 0 0 0 0 0.2 1 0.6

Listeriosis 0 0 0 2.2 7 5 27 27.8

Lyme Disease 2 0.2 4 2 53 28 185 90.4

Malaria 0 1.6 2 7.6 4 13.6 35 62

Measles (Rubeola) 0 0 0 1.4 0 0 11 3.8

Meningitis: Bacterial or Mycotic 0 0.4 0 6.8 13 12 93 115.4

Meningococcal Disease 0 0.4 0 1 1 2.4 19 40.6

Middle East Respiratory Syndrome (MERS) 0 0 0 0.2 0 0 1 0.2

Mumps 0 0.6 0 0.8 1 1.4 16 9

Pertussis 0 8.6 10 24.2 36 61.6 237 380.6

Rabies: Possible Exposure 10 7.6 63 61 250 231.2 2213 1735.4

Rocky Mountain Spotted Fever and Spotted Fever Rick-ettsiosis 0 0.2 1 0.4 2 1.4 30 6

Salmonellosis 34 39.6 189 176.8 731 789.6 3746 3554.8

Shigellosis 3 15 53 90.2 152 179.8 1525 1245.8

Strep pneumoniae Invasive Disease: Drug-Resistant 1 2 11 26.2 9 19.8 113 420.8

Strep pneumoniae Invasive Disease: Drug-Susceptible 2 1 15 16.8 5 17.8 182 419.2

Typhoid Fever (Salmonella Serotype Typhi) 0 0.2 0 1 0 1.8 6 10

Varicella (Chickenpox) 1 1.4 12 20 41 42 501 556.8

Vibriosis (Vibrio alginolyticus) 0 0.2 2 1.2 5 5.6 44 36.4

Vibriosis (Vibrio parahaemolyticus) 0 0.2 0 0.4 6 4.4 31 26.8

Vibriosis (Vibrio vulnificus) 0 0 0 0 6 6.4 28 22.2

West Nile Virus Neuroinvasive Disease 0 0.2 0 0.4 2 6.2 6 7.8

West Nile Virus Non-Neuroinvasive Disease 0 0.2 0 0.2 1 2.8 1 3.4

Total 307 307.6 2356 2126.2 6037 5215 44075 36007.8

Florida Department of Health: ESSENCE

Since 2007, the Florida Department of Health has

operated the Early Notification of Community-based

Epidemics (ESSENCE), a state-wide electronic bio-

surveillance system. The initial scope of ESSENCE

was to aid in rapidly detecting adverse health events

in the community based on Emergency Department

(ED) chief complaints. In the past seven years,

ESSENCE capabilities have continually evolved to

currently allow for rapid data analysis, mapping, and

visualization across several data sources, including

ED record data, Merlin reportable disease data,

Florida Poison Information Network consultations,

and Florida Office of Vital Statistics death records.

The majority of the information presented in this

report comes from ESSENCE. Florida currently has

186 emergency departments and 30 urgent care

centers (Florida Hospital Centra Care) reporting to

ESSENCE-FL for a total of 216 facilities.

Epidemiology Monthly Surveillance Report

Hospital linked to ESSENCE

Florida Hospital Centra Care Clinic linked to ESSENCE

Other Disease Resources

In the structure of DOH-Orange, tuberculosis, sexually transmitted infections,

and human immunodeficiency virus are housed in separate programs from the

Epidemiology Program. We recognize the importance of these diseases for

our community partners and for your convenience have provided links for

surveillance information on these diseases in Florida and Orange County.

Orange County West Nile Virus Advisory Update

On August 12, the Florida Department of Health in Orange County issued a Mosquito-borne

Illness Advisory. This advisory was in response to several sentinel chickens located in Orange

County testing positive for West Nile Virus

(WNV). The advisory is intended to make

the public aware that a detectable increase

for the risk of WNV has been identified in

Orange County. There is no vaccine for

WNV. Prevention guidance can be found

here.

More information on how DOH responds to

Mosquito-borne Illnesses can be found here.

DOH Mosquito-borne Illness Response Levels

Level 1 No Activity

Level 2 Background Activity

Level 3 Mosquito-borne Illness Advisory

Level 4 Mosquito-borne Illness Alert

The Epidemiology Program conducts disease surveillance and investigates suspected occurrences

of infectious diseases and conditions that are reported from physician’s offices, hospitals, and

laboratories.

Surveillance is primarily conducted through passive reporting from the medical community as

required by Chapter 381, Florida Statutes.

Data is collected and examined to determine the existence of trends. In cooperation with the Office

of Emergency Operations, the Epidemiology Program conducts syndromic and influenza-like-illness

surveillance activities.

Syndromic surveillance was added to the disease reporting process as an active method of

determining activities in the community that could be early indicators of outbreaks and bioterrorism.

Our staff ensures that action is taken to prevent infectious disease outbreaks from occurring in

Orange County communities and area attractions. Along with many public and private health

groups, we work for the prevention of chronic and long-term diseases in Central Florida.

Epidemiology Program

6101 Lake Ellenor Drive

Orlando, Florida 32809

Phone: 407-858-1420

Fax: 407-858-5517

http://orange.floridahealth.gov/

F l or i da D e p ar t m e nt o f H e a l th i n Or a n g e Co u n t y

ALL DATA IS PROVISIONAL

Issue Contributors

Sarah Matthews, MPH

Epidemiology Program Manager

Ben Klekamp, MSPH, CPH Epidemiologist

Debra Mattas, BS

Epidemiologist

Jack Tracy, M Ed Influenza Surveillance Coordinator

Charlene McCarthy

Administrative Assistant

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